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CMS Releases Guidance on Reentry Section 1115 Waiver Opportunity

In an April 17 letter to state Medicaid directors, the Centers for Medicare & Medicaid Services encouraged states to leverage a new Section 1115 demonstration to implement a service delivery system that facilitates reentry transitions for Medicaid-eligible individuals leaving prisons and jails.

This demonstration opportunity aims to:

  • Increase coverage, continuity of coverage, and appropriate service uptake.
  • Improve access to services.
  • Improve coordination and communication among correctional systems, Medicaid systems, managed care plans, and community-based providers.
  • Increase additional investments in health and health services for this population.
  • Improve connections between carceral settings and community services.
  • Reduce all-cause deaths in the near-term post-release.
  • Reduce the number of emergency department visits and inpatient hospitalizations among recently incarcerated Medicaid beneficiaries.

Elements of the Reentry Section 1115 demonstrations include:

  • Quality: Demonstration design should advance quality through its approaches to promoting access to coverage, care, transitions to the community, and quality of services, and meeting health-related social needs.
  • Carceral settings: Demonstrations should include state or local jails, prisons, or youth correctional facilities. States also may assist individuals in federal prisons to submit Medicaid applications.
  • Eligible individuals: Programs must include Medicaid-eligible individuals who are currently incarcerated and soon-to-be former incarcerated persons.
  • Medicaid eligibility and enrollment: States will be expected to suspend and not terminate Medicaid eligibility.
  • Scope of services: States will be required to provide services including, but not limited to, case management, medication-assisted treatment for substance use disorder, and a 30-day supply of all prescriptions immediately upon release.
  • Pre-release timeframe: States will be expected to cover demonstration services beginning from 30 to 90 days prior to release, depending on the service.
  • Administrative information technology system costs: Costs may be eligible for enhanced federal financial participation, including systems that support data sharing between state Medicaid agencies and correctional facilities.
  • Transitional, non-service expenditures: State may request time-limited support for necessary changes required by states, correctional facilities, and health care providers to implement these services.
  • Reinvestment plan: The plan should outline the aggregate amount of federal matching funds that is being requested and where reinvestments will be made.

America’s Essential Hospitals is analyzing the letter and will send members a detailed Action Update in the coming days.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Julie Kozminski is a policy manager at America's Essential Hospitals.

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